=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386556744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSE OF ELITE ADULT FAMILY HOME 2 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2026
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 S 259TH ST
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98198-9043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-261-6152
-----------------------------------------------------
Fax | 425-984-0552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 S 259TH ST
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98198-9043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-261-6152
-----------------------------------------------------
Fax | 425-984-0552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JAZMINE DEVANTIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-261-6152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------